What Minerva Knows That Pharma Does Not Yet

May 24th, 2016

Peter Keeling

Peter Keeling of Diaceutics discusses the Minerva supercomputer built by Mount Sinai Medical Center. It has the potential to be a disruptive force in the personalized medicine space as it bypasses the old guidelines-driven treatment paradigm marked by long-cycle industrial research, and replaces it with short-cycle bedside clinical innovation.

Minerva, Greek goddess of wisdom, may seem a strange place to start this brief perspective, especially since these Expert Insights are intended to be straight talking and to the point. But stay with me for a moment. The Minerva I refer to in the title is rather the Minerva supercomputer now running live at Mount Sinai. This is one of the first academic medical centers in the United States to build and operate a supercomputer for personalized medicine. But similar superpowered initiatives are also underway across leading cancer centres in Helsinki, London, San Francisco and Beijing.

According to Dennis S. Charney, MD, Dean of the Icahn School of Medicine at Mount Sinai, “With Minerva, Mount Sinai has the ability to quickly analyze genomic patterns to provide a greater understanding of the causes of disease and how to personalize treatments according to an individual’s genetic composition.” For all who still maintain personalized medicine is years away, take note please – personalized medicine has in fact arrived.

But this is a message, too, about pharma. We at Diaceutics have the privilege to work with some of the leading pharma companies advancing personalized medicine over recent years. This has provided us with a working insight to where projects are on the journey towards personalized medicine. In truth, pharma’s involvement in personalized medicine is running at two speeds right now. Those who understand the disruptive changes underway and those who don’t know where personalized medicine is inevitably taking us. Regardless of the awareness camp, the arrival of Minerva and its like, will illustrate that pharma has now tumbled over the edge of the ‘Influence Escarpment’, a concept we use to explain to our clients how and why they are no longer really in control of how the therapies they develop will get used in clinical practice. Simply put, Minerva bypasses the old guidelines-driven treatment paradigm marked by long-cycle industrial research, and replaces it with short-cycle bedside clinical innovation.

Life at the bottom of this Influence Escarpment will not be easy for pharma, primarily because companies are not prepared ‘yet’ to let go of the old treatment model. Yes, recent personalized medicine launches have been smart and have sought to integrate the treatment and test in a physician-centric education package. This supply of critical components into the clinic is, in our view, personalized medicine at its first big milestone, or PM 1.0. Pfizer’s Xalkori launch and Biogen’s Tysabri JCV antibody test launch illustrate the current state of the PM 1.0 art, namely smart joined-up communication around Rx/Dx combination products (as the FDA would call them).

But the switching on of Minerva at Mount Sinai (that sounds vaguely historical) ultimately embeds the influence for treatment choices inside a complex knowledge-based system, far away from the empiricism of physicians and evidence-based guidelines, the latter of which pharma’s business model, even under PM1.0, fitted well.

Minerva and its like demand a new business model to ensure that pharma can climb back up the Influence Escarpment. What’s needed is a model where pharma is no longer a peripheral (albeit critical) component supplier but rather a harnesser of the energy locked up in its patient and treatment research and pharmacogenetic insights. Pharma needs to be at the centre of the integration of personalized medicine into clinical practice. This systems integration approach has marked the modern business models of companies like Google and IBM in that other highly complex and fragmented supply chain business.

So Minerva, that goddess of wisdom, might say that PM2.0 is not about new smarter components and better market education, but about finding the players with the pockets deep enough to become the industrial integrators, like their brothers in the IT world. On the other hand, Minerva the clinical supercomputer might say, “I’ll take it from here guys!”

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